Airway management of postburn neck contracture in pediatric patient - A challenge for anesthesiologist!

Pediatric difficult airway management is more challenging for an anesthesiologist due to anatomical and physiological differences as compared to adults. Moreover, the familiarity with the use of difficult airway equipment in adults does not equate to proficiency for the same in children. So, here we are presenting the management of a unique case of a difficult airway due to postburn neck contracture in a 4-year-old child, which was managed successfully with the help of a video laryngoscope after the failure attempt with a flexible fiberoptic bronchoscope.

Pulmonary tuberculosis and neurologic melioidosis coinfection-first case report from Madurai

Despite tuberculosis and melioidosis being endemic in many countries, coinfections are unusual. Only fourteen cases of tuberculosis melioidosis coinfections have been reported. To the best of our knowledge, this is the first case of coinfection of tuberculosis and neurologic melioidosis. We report a case of 48 year diabetic male presented with fever, headache and altered sensorium for two days. On examination, there was scalp abscess with subgaleal hematoma, pus culture of which grew B. pseudomallei. Sputum culture grew the same and sputum tuberculosis PCR was positive. Patient was concurrently treated for both the conditions and recovered.

Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

Introduction

Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients.

Materials and methods

This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected.

Results

Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference).

Conclusion

To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

Mesocosm experiment reveals scale dependence of movement tendencies in sticklebacks

Habitat fragmentation can have negative impacts on migratory organisms that rely on the functional connectivity between growing and breeding grounds. Quantifying the population-level phenotypic consequences of such fragmentation requires fine-scaled tracking of individual behaviour and movements across relevant scales. Here we make use of a natural experiment where some populations of 'migrant' three-spined sticklebacks (Gasterosteus aculeatus) became 'residents', following habitat fragmentation five decades ago. To test whether residents have a lower movement tendency than migrants, we developed a novel experimental platform that allows the automated tracking of individual movements via RFID technology in a semi-natural mesocosm where spatio-temporal scales and environmental conditions can be manipulated. We found that residents moved significantly less than migrants at large but not at small spatial scale. This pattern was consistent across time and contexts (water flow and group size). Our study substantiates prior literature on rapid phenotypic divergence in sticklebacks in response to human-induced isolation and highlights the importance of observing behaviour in ecologically relevant set-ups that bridge the gap between laboratory and field studies.

P-043 A RETROSPECTIVE OUTCOME REVIEW OF THE USE OF EGIS ACELLULAR DERMAL MATRIX DURING ABDOMINAL WALL RECONSTRUCTION

Aim

We aimed to demonstrate the relative safety profile of an established non-crosslinked porcine acellular dermal matrix (ADM) during abdominal wall reconstruction.

Material & Methods

Individual real-world safety data on specific mesh products are often lacking. With recent media scrutiny over the use of mesh, we sought to quantify outcomes and demonstrate the safety of a specific ADM (reference 1). A retrospective casenote-based outcome analysis was performed on patients who underwent mesh augmentation during abdominal wall reconstruction from two NHS institutions. Both elective and emergency patients were included from January 2018 to December 2021.

Results

Fifty-five patients were included in the study across two NHS specialist hernia centres. We identified a mean wound infection rate of 14.2% (range 2–22%) with a median follow up of 9 months (range 3–18 months). Hernia recurrence rate was 10.4% (range 5–22%). We found 7 patients (12%) developed a seroma, 1 of whom required seroma aspiration. Only 4 patients (7%) had post-operative dehiscence requiring further intervention, all of whom had Ventral Hernia Working Group (VHWG) Grade 3 or 4 wounds pre-operatively.

Conclusions

Our data supports the continued use of a widely available ADM for abdominal wall reconstruction in both elective and emergency cases, highlighting its positive relative safety profile.

Isolation and genetic analysis of Porcine circovirus 2 in southern India evidences high circulation of Porcine circovirus 2d genotype

BACKGROUND

Porcine circovirus 2 is globally noted swine pathogen with multiple genotypes associated with vast clinical and subclinical outcomes. This study aimed to isolate and characterize PCV2 genotypes circulating in southern states of India.

METHODS AND RESULTS

A total of 434 field samples comprising of serum (n = 273), tissues (n = 109) and swabs (n = 52) collected from swine during 2019 to 2021 from southern states of India were screened for PCV2 by specific polymerase chain reaction (PCR) assay. Molecular prevalence of PCV2 in southern India was found to be 12.21% (n = 53). All the 53 PCV2 positive samples were further subjected to the PCR assay with designed primers targeting full length amplification of ORF2 gene of PCV2 for molecular characterization. Randomly 32 positive samples by full length PCV2-ORF2 gene PCR were sequenced for genotyping. Signature motif and phylogenetic analysis of 32 PCV2 sequences revealed 62.5% (n = 20) prevalence of PCV2d genotype followed by 21.8% (n = 7) of PCV2h or PCV2-IM1 and 15.6% (n = 5) of PCV2b genotypes. Twenty five PCR positive field samples were subjected for virus isolation in PK15 cells and characterized. Out of 25 samples processed 5 (20%) PCV2 isolates obtained in this study were confirmed by PCR and immune fluorescence assay. Molecular characterization of PK15 adapted five PCV2 isolates confirmed circulation of PCV2d, PCV2h and PCV2b genotypes in pigs under field conditions in southern India.

CONCLUSIONS

Isolation and molecular epidemiological study of PCV2 in southern states of India evidences high circulation of PCV2d genotypes in field conditions in comparison to other genotypes.

CFD simulation on optimum material to fabricate the counter flow of Ranque-Hilsch vortex tube

The basic objective of the current investigation by using CFD simulation is to select the appropriate material to fabricate Vortex tubes in meteorological conditions, which can improve efficiency and performance. The simulation results of vortex tubes were used in obtaining the performance for various materials such as copper, stainlessteel, brass, PVC, CPVC, acrylic, nylon, and bronze. The ratio of length of the hot tube and inner diameter was chosen as (L/D) 40 with the consistent inner diameter of the hot tube as 15 mm. Compressed air is passed through an inlet pipe between 2 and 12 bars in the step of 2 bars. 2D CFD was developed and analyzed with Ansys Fluent to access the performance of the vortex tube. Finally, after evaluating all simulation values for eight materials for performance depending upon their physical properties varies in the sequence from copper–bronze–brass–stainless steel–CPVC–PVC–acrylic–nylon material.

Molecular evidence of porcine circovirus 3 infection in swine: first report in southern India

The present study examined 434 field samples including serum (n = 273), swabs from natural orifices (n = 52) and postmortem tissue samples (n = 109) from both suspected and asymptomatic swine from Andhra Pradesh, Karnataka, Kerala, Pondicherry, Tamil Nadu, and Telangana states in southern India. All the samples were processed for molecular screening of PCV3 by specific PCR assay. Overall molecular positivity rate of PCV3 was found to be 0.7% in southern India with one sample positive from each state of Tamil Nadu, Kerala and Telangana. All the three PCR positive PCV3 samples are detected from reproductive failures and were processed and propagated in PK15 cell line for virus isolation. Out of 3 samples processed, one (INDKL9PK76) PCV3 isolate could be obtained in this study and it was confirmed by specific PCR at third and fifth passage levels. Sequencing of PCV3 positive PCR amplicon (INDKL9PK76) revealed 1004 nucleotides and BLAST analysis confirmed partial sequence of the PCV3 genome. The aligned contig sequence was submitted to GenBank under the accession number of MW627201. PCV3 sequence in this study revealed 99% homology with PCV3 isolates from Europe and China. Phylogentic analysis of the PCV3 isolate-INDKL9PK76 sequence along with established PCV3 genotypes revealed clustering within PCV3 genotypes. Characterization of PCV3 (INDKL9PK76) isolate based on deduced amino acid composition of PCV3-capsid protein revealed "A" (alanine) and "R" (arginine) at 24th and 27th residues respectively confirming the incidence of PCV3a genotype. This study evidences PCV3 associated reproductive failure in domestic pigs for the first time in southern India.

Genomic testing for copy number and single nucleotide variants in spermatogenic failure

PURPOSE

To identify clinically significant genomic copy number (CNV) and single nucleotide variants (SNV) in males with unexplained spermatogenic failure (SPGF).

MATERIALS AND METHODS

Peripheral blood DNA from 97/102 study participants diagnosed with oligozoospermia, severe oligozoospermia, or non-obstructive azoospermia (NOA) was analyzed for CNVs via array comparative genomic hybridization (aCGH) and SNVs using whole-exome sequencing (WES).

RESULTS

Of the 2544 CNVs identified in individuals with SPGF, > 90% were small, ranging from 0.6 to 75 kb. Thirty, clinically relevant genomic aberrations, were detected in 28 patients (~ 29%). These included likely diagnostic CNVs in 3/41 NOA patients (~ 7%): 1 hemizygous, intragenic TEX11 deletion, 1 hemizygous DDX53 full gene deletion, and 1 homozygous, intragenic STK11 deletion. High-level mosaicism for X chromosome disomy (~ 10% 46,XY and ~ 90% 47,XXY) was also identified in 3 of 41 NOA patients who previously tested normal with conventional karyotyping. The remaining 24 CNVs detected were heterozygous, autosomal recessive carrier variants. Follow-up WES analysis confirmed 8 of 27 (30%) CNVs (X chromosome disomy excluded). WES analysis additionally identified 13 significant SNVs and/or indels in 9 patients (~ 9%) including X-linked AR, KAL1, and NR0B1 variants.

CONCLUSION

Using a combined genome-wide aCGH/WES approach, we identified pathogenic and likely pathogenic SNVs and CNVs in 15 patients (15%) with unexplained SPGF. This value equals the detection rate of conventional testing for aneuploidies and is considerably higher than the prevalence of Y chromosome microdeletions. Our results underscore the importance of comprehensive genomic analysis in emerging diagnostic testing of complex conditions like male infertility.

Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?

BACKGROUND

The commonly used predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) have subjective assessment components and can be used only in the postoperative setting. Also, the available objective predictors based on preoperative cross-sectional imaging were not prospectively studied.

AIM

To evaluate the accuracy of the pancreatic attenuation index (PAI) and pancreatic enhancement ratio (PER) for predicting CR-POPF following PD and its correlation with pancreatic fat fraction and fibrosis.

METHODS

A prospective observational study included patients who underwent PD for benign and malignant pathology of the periampullary region or pancreatic head between February 2019 and February 2021. Patients undergoing extended or total pancreatectomy and those with severe atrophy of pancreatic tissue or extensive parenchymal calcifications in the pancreatic head and neck precluding calculation of PAI and PER were excluded from the study. Preoperatively PAI was measured in the neck of the pancreas by marking regions of interest (ROI) in the non-contrast computed tomography (CT), and PER was measured during the contrast phase of the CT abdomen. Also, the fibrosis score and fat fraction of the pancreatic neck were assessed during the histopathological examination. Demographic, clinical and preoperative radiological indices (PAI, PER) were evaluated to predict CR-POPF. Preoperative pancreatic neck CT indices were correlated with the histopathological assessment of fat fraction and fibrosis.

RESULTS

Of the 70 patients who underwent PD, 61 patients fulfilling the inclusion criteria were included in the analysis. The incidence of CR-POPF was 29.5% (18/61). PAI had no association with the development of CR-POPF. Of the preoperative parameters, PER (mean ± standard deviation [SD]) was significantly lower in patients developing CR-POPF (0.58 ± 0.20 vs 0.81 ± 0.44, P = 0.006). The area under the curve for the PER was 0.661 (95%CI: 0.517-0.804), which was significant (P = 0.049). PER cut-off of 0.673 predicts CR-POPF with 77.8% sensitivity and 55.8% specificity. PAI and PER had a weak negative correlation (Strength-0.26, P = 0.037). Also, PER showed a moderately positive correlation with fibrosis (Strength 0.50, P < 0.001). Patients with CR-POPF had a significantly higher incidence of the intraabdominal abscess (50% vs 2.3%, P < 0.001), delayed gastric emptying (83.3% vs 30.2, P < 0.001), and prolonged mean (± SD) postoperative hospital stay (26.8 ± 13.9 vs 9.6 ± 3.6, P = 0.001).

CONCLUSION

PER exhibited good accuracy in predicting the development of CR-POPF. PER additionally showed a good correlation with PAI and fibrosis scores and may be used as an objective preoperative surrogate for assessing pancreatic texture. However, ROI-based PAI did not show any association with CR-POPF and pancreatic fat fraction.

Molecular detection of porcine parvovirus 1-associated reproductive failure in southern India

This study used 56 aborted and stillborn fetuses from organized swine farms in Tamil Nadu and Kerala, southern states of India. All samples were screened by using a PCR assay that targets the NS1 gene for PPV. Furthermore, the PCR positive samples were subjected to amplification of the VP2 gene of PPV1 with designed primers and sequenced for further study. The PCR screening of 56 samples found that 14.3% (n = 8) were positive for PPV genome. According to VP2 gene–based PCR for PPV1, 897 bp specific amplicons were detected in all eight of the samples. Two of the eight positive samples (L17 and T5) were sequenced and annotated randomly. The BLAST analysis of contig sequence INDTNCHN-T5 revealed 100% sequence homology with Chinese PPV1genome, whereas sequence from INDTNCHN-L17 revealed 99.43% sequence homology with Spain, Chinese, and German. PPV1 sequences and both the sequences INDTNCHN-T5 and INDTNCHN-L17 were submitted to the GenBank under the accession numbers MW822566 and MW822567 respectively. A phylogenetic analysis of the sequences in this study revealed specific grouping along with PPV1 strains in cluster E. Amino acid analysis of both isolated sequences in addition to the reference sequence from PPV1 showed variations in position 215 (I to T) in both the isolates, variation at position 228 (Q to E) in T5 isolate and variations at position 59 (L to M) and 314 (K to E) in L17 isolate. This study represents the first report of PPV1 cluster E in Tamil Nadu, southern India.

Nasoethmoidal Schwannoma as a Mimicar of Esthesioneuroblastoma: A Case Report and Literature Review

Nasoethmoidal schwannomas are rare lesions and their presentation with intracranial extension is even rarer. Here, a patient presenting with rhinorrhea, epistaxis, and proptosis of left eye was diagnosed with giant nasoethmoidal schwannoma extending to frontal lobe and orbit, which was managed with bifrontal craniotomy with endoscopic transnasal gross total excision. This being predominantly a benign lesion has good prognosis if total excision is achieved.

Does genetic differentiation underlie behavioral divergence in response to migration barriers in sticklebacks? A common garden experiment

Abstract

Water management measures in the 1970s in the Netherlands have produced a large number of “resident” populations of three-spined sticklebacks that are no longer able to migrate to the sea. This may be viewed as a replicated field experiment, allowing us to study how the resident populations are coping with human-induced barriers to migration. We have previously shown that residents are smaller, bolder, more exploratory, more active, and more aggressive and exhibited lower shoaling and lower migratory tendencies compared to their ancestral “migrant” counterparts. However, it is not clear if these differences in wild-caught residents and migrants reflect genetic differentiation, rather than different developmental conditions. To investigate this, we raised offspring of four crosses (migrant ♂ × migrant ♀, resident ♂ × resident ♀, migrant ♂ × resident ♀, resident ♂ × migrant ♀) under similar controlled conditions and tested for differences in morphology and behavior as adults. We found that lab-raised resident sticklebacks exhibited lower shoaling and migratory tendencies as compared to lab-raised migrants, retaining the differences in their wild-caught parents. This indicates genetic differentiation of these traits. For all other traits, the lab-raised sticklebacks of the various crosses did not differ significantly, suggesting that the earlier-found contrast between wild-caught fish reflects differences in their environment. Our study shows that barriers to migration can lead to rapid differentiation in behavioral tendencies over contemporary timescales (~ 50 generations) and that part of these differences reflects genetic differentiation.

Significance statement

Many organisms face changes to their habitats due to human activities. Much research is therefore dedicated to the question whether and how organisms are able to adapt to novel conditions. We address this question in three-spined sticklebacks, where water management measures cut off some populations, prohibiting their seasonal migration to the North Sea. In a previous study, we showed that wild-caught “resident” fish exhibited markedly different behavior than migrants. To disentangle whether these differences reflect genetic differentiation or differences in the conditions under which the wild-caught fish grew up, we conducted crosses, raising the F1 offspring under identical conditions. As their wild-caught parents, the F1 of resident × resident crosses exhibited lower migratory and shoaling tendencies than the F1 of migrant × migrant crosses, while the F1 of hybrid crosses were intermediate. This suggests that ~ 50 years of isolation are sufficient to induce behaviorally relevant genetic differentiation.

A Hospital Based Cross Sectional Study of Midline Cutaneous Lesions in Neonates and its Association with Spinal Dysraphism Detected Using Ultrasound

Background:

Spinal dysraphism occurs due to incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine. The defects in the spinal cord can be associated with skin lesion since both have same embryonic origin.

Aims and Objectives:

This study was conducted to determine the association of midline and paramedian cutaneous lesions with spinal dysraphism by using spinal ultrasonography.

Materials and Methods:

Two thousand apparently healthy neonates were screened in the postnatal ward of a tertiary care center in South India. Those neonates with cutaneous lesions in the midline and paramedian region were screened for evidence of spinal dysraphism by using spinal ultrasonography.

Results:

Among 2000 neonates, 120 (6%) had at least one cutaneous lesion, of which 114 (5.7%) were in the midline and 6 (0.3%) were on the paramedian region of dorsal and ventral aspect of the body. Among these neonates, two cases had more than one skin lesions. The most common cutaneous lesion observed was typical dimple (82, 68%) followed by hypertrichosis (12, 10%). Ultrasonography revealed spinal anomaly in six (5%) of them. The cutaneous lesions associated with spinal dysraphism were obvious midline swelling, dermal sinus, and multiple skin lesions.

Conclusion:

Congenital midline and paramedian skin lesions may be the marker of spinal dysraphism. In the presence of such cutaneous lesions, only 5% of them had associated spinal anomaly in our study.

Hand Full of Sausages-Forme Frustae of Severe Psoriatic Arthritis: A Case Report

Dactylitis or sausage shaped digits is one of the hallmark features of psoriatic arthritis which occurs in association with psoriasis. This is a report of 50-year-old female, known case of psoriasis vulgaris, presented with complaints of red, painful and swollen digits of both hands since two weeks. She also complained of pain and restricted movements of all small joints of hands since two days. On examination, all the digits were erythematous, tender and swollen. Investigations revealed elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP), negative rheumatoid factor and x-ray hands showed joint space narrowing and soft tissue swelling. Based on Classification Criteria for Psoriatic Arthritis (CASPAR) with score of 3/6, psoriatic arthritis was diagnosed. Further evaluation of other joints revealed features of sacroiliitis in x-ray pelvis. Psoriatic dactylitis involving all digits and as an initial symptom of psoriatic arthritis is rarely reported in literature. Dactylitis involving all the digits may be a forerunner of severe psoriatic arthritis.

Practical consensus recommendations on management of HR + ve early breast cancer with specific reference to genomic profiling

Breast cancer is a heterogeneous disease and patients are managed clinically based on ER, PR, HER2 expression, and key risk factors. The use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. Most guidelines for hormone receptor (HR)–positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. Expert oncologist discussed about strategies of gene expression assays and aid in chemotherapy recommendations for treatment of HR + ve EBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Recent advances in the synthesis and applications of mordenite zeolite - review

Among the many industrially important zeolites, mordenite is found to be interesting because of its unique and exceptional physical and chemical properties. Mordenite (high silica zeolite) is generally prepared by the hydrothermal method using TEA+ cations. TEA+ cations are the best templating agent, though they can create a number of issues, for instance, generating poison and high manufacturing cost, wastewater contamination, and environmental pollution. Hence, it is necessary to find a mordenite synthesis method without using an organic template or low-cost template. In this review, a number of unique sources were used in the preparation of mordenite zeolite, for instance, silica sources (rice husk ash, silica gel, silica fumes), alumina sources (metakaolin, faujasite zeolite) and sources containing both silica and alumina (waste coal fly ash). These synthesis approaches are also based on the absence of a template or low-cost mixed organic templates (for instance, glycerol (GL), ethylene glycol (EG), and polyethylene glycol 200 (PEG)) or pyrrolidine-based mesoporogen (N-cetyl-N-methylpyrrolidinium) modifying the mordenite framework which can create unique properties. The framework properties and optical properties (indium-exchanged mordenite zeolite) have been discussed. Mordenite is generally used in alkylation, dewaxing, reforming, hydrocracking, catalysis, separation, and purification reactions because of its large pore size, strong acidity, and high thermal and chemical stability, although the applications are not limited for mordenite zeolite. Recently, several applications such as electrochemical detection, isomerization, carbonylation, hydrodeoxygenation, adsorption, biomass conversion, biological applications (antibacterial activity), photocatalysis, fuel cells and polymerization reactions using mordenite zeolite were explored which have been described in detail in this review.

Anticipating Urinary Retention Following Total Hip and Total Knee Replacements

Introduction

Urinary retention is a widely recognised postoperative complication. Although anecdotally lower limb arthroplasty is linked with high rates of urinary retention, there are no current accepted standards for determining which patients are at higher risk and should therefore be offered intra operative catheterisation.

Materials and Methods

One hundred patients, 55 females and 45 males, who underwent uncomplicated total hip or total knee replacements at Furness General Hospital were recruited between January and April 2017.

Results

Post-operative urinary retention was seen frequently, with 38 patients (38%) requiring post-operative catheterisation. Twenty-one males (46%) developed postoperative retention compared to 17 (30%) of females, representing a statistically significant increase in risk seen in male patients. (p 0.009). Post-operative urinary retention requiring catheterisation was associated with increasing age, with those over 75 years having a significantly higher risk than those less than 75 years irrespective of gender (p 0.04). There was no significant difference in urinary retention rates between patients who had general (n=21) or spinal anaesthetic (n=79) with 33% of GA patients and 39% of spinal anaesthetic patients requiring catheterisation (p 0.17).

Conclusion

There are increased rates of urinary retention seen in lower limb arthroplasty patients than those described in the general surgical population, with male patients and all those over 75 years of age having a significantly higher risk. Clinically, it may therefore be sensible to consider offering routine intra operative catheterisation to this cohort of patients.

Combustion and emission analysis of hydrogenated waste polypropylene pyrolysis oil blended with diesel

Petroleum-based plastic pyrolysis oil contains unsaturated compounds, and the presence of these compounds makes the produced fuel unsuitable for combustion in diesel engines. Hydrogenation of pyrolysis oil is performed to convert unsaturated compounds to saturated compounds. Past studies have shown that hydrogenation of petroleum-based plastic pyrolysis oil is viable; however, its combustion and emissions analysis in diesel engines has not yet been reported. In this study, we investigated the combustion, performance, and emissions of hydrogenated polypropylene pyrolysis oil (HPPO) blended with diesel. Polypropylene (PP) was converted to pyrolysis oil using ZSM-5 as the catalyst. The hydrogenation of polypropylene pyrolysis oil (PPO) was conducted at pressure of 70 bar, and the reaction temperature was maintained at 350 °C. Ni metal impregnated on the ZSM-5 base support was used as the catalyst of choice. The produced HPPO possessed physicochemical properties that match the EN590 standards(European diesel fuel standards). Gas chromatography-mass spectrometry (GC-MS) studies of PPO and HPPO showed the effectiveness of hydrogenation for the complete conversion of alkenes to alkanes, and hydrocracking resulted in cracking higher carbon number alkanes to lower values. HPPO was blended with diesel in ratios of 10 wt.%, 20 wt.%, 30 wt.%, and 40 wt.%. The diesel engine performance results for the blended fuel showed combustion, performance, and emissions on par with pure diesel fuel for blending ratios up to 20 wt.%. As is known, plastic solid waste (PSW) materials pose serious hazards to the environment. Our HPPO physicochemical properties matched the EN590 standards for diesel fuel. The combustion of HPPO in diesel engines can provide an option for environmentally cleaner disposal of PSW.

Subclinical Atherosclerosis and Atherogenic Index of Plasma in Lichen Planus Patients- A Comparative Cross-sectional Study

Introduction: Lichen Planus (LP) is an idiopathic and chronic inflammatory disease that affects the skin and the mucous membranes, and studies have proven its association with increased risk for Cardiovascular (CV) diseases. Subclinical atherosclerosis and Atherogenic Index of Plasma (AIP) are strong predictors of CV risk. Aim: The primary aim of this study was the evaluation of Common Carotid artery mean Intima-Media wall Thickness (CIMT) and AIP which are predictors of CV risk in patients with LP. Materials and Methods: Fifty patients with LP and fifty age, gender and Body Mass Index (BMI) matched healthy controls (from the general population without the disease) were included in the study. CIMT was measured using ultrasound. Lipid profile was calculated by biochemical analysis. AIP was calculated from lipid profile using validated formula. Data was analysed using SPSS version 16.0 software. Results: Compared to healthy controls, patients had significantly higher CIMT. A 28% of patients had subclinical atherosclerosis compared to 2% of controls (p<0.001). Dyslipidemia was detected in 42% of patients and only 10% of controls (p<0.001). AIP was significantly elevated in LP patients compared to controls (p<0.001). A 36% of patients had high CV risk according to AIP versus 8% of controls. The 80% of controls had low CV risk versus 48% of patients (p<0.001). Conclusion: LP patients were found to have increased CV risk. CIMT, lipid profile and AIP can serve as important diagnostic markers of CV risk. Educating the patients about such a risk will enable them to follow lifestyle modifications so as to prevent further complications and morbidity.

Neuromyelitis optica spectrum disorder and systemic lupus erythematosus

Neuromyelitis optica spectrum disorder is an inflammatory syndrome that is associated with many autoimmune conditions. We present the case of a patient who had longitudinally extensive transverse myelitis and antibodies to aquaporin 4 IgG (AQP4-IgG). Based on presence of lymphopenia, further workup revealed strong ANA positivity, anti-Sm antibodies, and low serum complements suggesting presence of systemic lupus erythematosus. The patient promptly responded to intravenous pulse methylprednisolone and five sessions of plasma exchange. At 1 year, she is on maintenance treatment with low dose prednisolone, azathioprine, and hydroxychloroquine, she has had no relapse and no other clinical features of lupus. This case is an illustration that neuromyelitis optica spectrum disorder can be the first manifestation of systemic lupus erythematosus.

Neuromyelitis optica spectrum disorder and systemic lupus erythematosus

Neuromyelitis optica spectrum disorder is an inflammatory syndrome that is associated with many autoimmune conditions. We present the case of a patient who had longitudinally extensive transverse myelitis and antibodies to aquaporin 4 IgG (AQP4-IgG). Based on presence of lymphopenia, further workup revealed strong ANA positivity, anti-Sm antibodies, and low serum complements suggesting presence of systemic lupus erythematosus. The patient promptly responded to intravenous pulse methylprednisolone and five sessions of plasma exchange. At 1 year, she is on maintenance treatment with low dose prednisolone, azathioprine, and hydroxychloroquine, she has had no relapse and no other clinical features of lupus. This case is an illustration that neuromyelitis optica spectrum disorder can be the first manifestation of systemic lupus erythematosus.

Development of a Fuel Quantity based Engine Control Unit Software Architecture

   Conventionally diesel engines are controlled in open loop with maps based on engine speed and throttle position wherein fuel quantity is indirectly fixed using the rail pressure and injection duration maps with engine speed and throttle position as the independent variables which are measured by the respective sensors. In this work an engine control unit (ECU) software architecture where fuel quantity is directly specified in relation to the driver demand was implemented by modifying the control logic of a throttle position based framework. A desired fuel quantity for a given engine speed and throttle position was mapped from base line experiments on the reference engine. Injection durations and rail pressure required for this quantity was mapped on a fuel injector calibration test bench. The final calculation of injection duration in the new architecture is calculated using the fuel injector model. This enables determination of fuel quantity injected at any moment which directly indicates the torque produced by the engine at a given speed enabling smoke limited fuelling calculations and easing the implementation of control functions like all-speed governing.

Facile synthesis of core-shell nanocomposites Au catalysts towards abatement of environmental pollutant Rhodamine B

Magnetically recoverable Au nanoparticles immobilized/stabilized on core-shell nanocomposites are synthesized by the combination of suspension polymerization as well as surface initiator atom transfer radical polymerization (SI-ATRP) methods. The magnetic core-shell supported Au nanocatalysts are namely Fe₃O₄-PAC-AuNPs, Fe₃O₄-PVBC-g-PAC-AuNPs, Fe₃O₄-HEA-AuNPs, and Fe₃O₄-PVBC-g-HEA-AuNPs. Among all the catalysts, Fe₃O₄-PVBC-g-PAC-Au NPs exhibited an excellent activity in the reduction of Rhodamine B with an apparent rate constant of 10.77 × 10^-3 s^-1 and TOF value of 47.62 × 10^-3 s^-1 under pseudo-first order reaction condition. Further, Fe₃O₄-PVBC-g-PAC-Au NPs has an outstanding activity and recyclability without applying any external magnetic field. This new approach provides an exciting potential way in the preparation of recyclable metal nano-catalysts with high catalytic activity.

Knowledge, Attitudes and Smoking Behaviours Among Dental and Medical Students in Chennai, Tamil Nadu, India

Background: Healthcare professionals have an important role to play both as advisers influencing smoking cessation and as role models. However, many of them continue to smoke. Several studies have demonstrated the efficacy of smoking cessation programs and the importance of physician's advice to their patients. The aims of the current study are as follows: (i) to evaluate smoking prevalence, knowledge and attitudes, and tobacco cessation training (ii) to examine the difference between smokers and nonsmokers. Methods: A structured questionnaire consisting of 14 questions related to tobacco/smoking habits, cessation training and role of health professionals in tobacco control were asked to the study population and their response was recorded. Random sampling method was used and data were collected from a cross-sectional survey. The survey was conducted between January and February 2015. Statistical analysis was done using SPSS version 17 and logistic regression model was used to identify possible associations with tobacco smoking status. The level of significance was p ≤ 0.05. Results: A total of 259 answered the questionnaire of which 29% declared to be smokers. About 53% of the males have smoked at least once in their life and the age of cigarette initiation was 16-17 years for 28% of the sample. 76% considered health professionals as behavioral models for patients, and 96% affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 87% heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. 93% of the sample agreed that health professionals should receive specific training on smoking cessation according to while 6% were of the opposite opinion. Conclusion: All healthcare professionals play an important role in the process of smoking cessation both as advisers and behavioral models for the general population. The current study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in medicine and dentistry, their key role both as advisers and behavioral models, and the limited tobacco training offered in the curriculum. In the field of public health, tobacco screening, and intervention is one of the most effective clinical preventive services. Planning and implementing smoking cessation training and cessation tailored to these young health professionals is therefore strongly recommended.

Granulomatous slack skin syndrome: Report of a unique case

Granulomatous slack skin syndrome is a rare variant of cutaneous T-cell lymphoma (mycosis fungoides). It is characterized clinically by redundant skin folds, which show a predilection towards flexural areas such as the axilla and the groin. Histologically, it shows a granulomatous T-cell infiltrate and loss of elastic tissue. It has an indolent but progressive course; and is usually refractory to treatment. We report a unique case of slack skin syndrome, sparing the classical sites with rapid and unusual involvement of non-intertriginous areas.

Meeting report, “First Indian national conference on cervical cancer management - expert recommendations and identification of barriers to implementation”

Objective

In India, cervical cancer accounts for almost 14% of all female cancer cases. Although poverty continues to cast a wide net over the Indian subcontinent, the preceding three decades have borne witness to improvements in nutrition and sanitation for many citizens. However, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. Treatment of cervical cancer is stage-specific and depends on the patient’s age, desire to preserve fertility, overall health, the clinician’s expertise, and accessibility to resources. There is a paucity of uniform treatment protocols for various stages of cervical cancer in India. Considering all these parameters, a need to optimize treatment paradigms for the Indian population emerged.

Methods/materials

Three expert panel meetings were held in different regions of India from 2016 to 2017. They were comprised of 15 experts from across the country, and included surgical oncologists, radiation oncologists, and medical oncologists. The panel members reviewed the literature from both national and global sources, discussed their clinical experience and local practices and evaluated current therapeutic options and management gaps for women diagnosed with cervical cancer.

Results

This article summarizes the expert opinion from these meetings. It discusses the available resources and highlights the current therapeutic options available for different cervical cancer stages: early stage disease, locally advanced tumors, recurrent/persistent/metastatic cancer. An Indian consensus governing treatment options emerged, including guidelines for use of the only approved targeted therapy in this disease, the anti-angiogenesis drug, bevacizumab.

Conclusions

The panel concluded that given the availability of state-of-the-art imaging modalities, surgical devices, radiotherapeutics, and novel agents in several population-dense urban centers, a uniform, multi-disciplinary treatment approach across patient care centers is ideal but not realistic due to cost and a paucity of third party payors for most Indian citizens. Preventative strategies including visual inspection with acetic acid to screen for precursor lesions (i.e., cervical intraepithelial neoplasia) with immediate referral for cervical cryotherapy and possible large-scale roll-out of the HPV vaccine in the near future can be expected to reduce mortality rates significantly in this country.

Clinico epidemiological and mycological study of pityriasis versicolor PITYRIASIS VERSICOLOR

Background: Pityriasis versicolor, a chronic superficial fungal infection caused by lipophilic yeasts of the genus, Malassezia is a common infection in the tropical and subtropical regions. Objective was to study the epidemiology, clinical presentation, associations, etiological agents and clinico-mycological correlation of pityriasis versicolor. 
Methods: Hundred patients with clinical diagnosis of pityriasis versicolor who attended the mycology out-patient (OP) clinic between September 2014 and August 2015 were enrolled. Skin scrapings from these patients were subjected to 10% potassium hydroxide (KOH) and culture.Results: Out of the 100 patients with pityriasis versicolor (PV), 70% were males and 30% were females and the most affected age group was between 21-30 years (43%). The youngest age affected was a 13 years old male while the oldest was a 65 years old male. Duration of the infection ranged between 1 month to 6 months in 65% while it was more than 1 year in 9% of patients. Recurrence was observed in 35% of them. Back was the most common site (48%) to be involved. Seventy percent of patients had more than 30% body surface area involvement. Achromic type of PV was the most common clinical presentation in 68% of patients. Out of the 76 isolates, Malassezia globosa was the predominant isolate (48.7%), followed by M. sympodialis (25%), M. furfur (10.5%), M. restricta (7.9%) and M. obtusa (6.6%).Conclusions: Achromic type of PV is the most common clinical presentation. Malassezia globosa is the most common etiological agent of pityriasis versicolor.

Assessing the Appropriateness of Oral Anticoagulation for Atrial Fibrillation in Advanced Frailty: Use of Stroke and Bleeding Risk-Prediction Models

BACKGROUND

Atrial fibrillation (AF) is common among frail older adults. Oral anticoagulation (OAC) is particularly challenging for these due to overlapping stroke and bleeding risk factor profiles.

OBJECTIVE

To compare the utility of stroke and haemorrhage risk-prediction instruments in the treatment of AF among frail older adults.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

Frail residents in four nursing homes with a Clinical Frailty Scale score ≥5 (median 7±0).

MEASUREMENTS

The prevalence of AF was assessed by ECG and chart review. Stroke (CHADS2 and CHA2DS2-VASc) and bleeding (HASBLED and HEMORR2HAGES) risk-prediction scores were then applied. A validated, risk-based, colour-coded decision support tool, incorporating these instruments, was then used to create a risk matrix and assess the appropriateness of OAC.

RESULTS

In total, 225 patients were included. The distribution of CFS scores was similar irrespective of AF status. In all, 86/225 (38%) had any history of AF. Of these, only 15/86 (17%) were prescribed OAC. All those in AF scored ≥2 on the CHA2DS2-VASc. One-third also scored high-risk of bleeding using HAS-BLED or HEMORR2HAGES. Risk-prediction scores were similar between those with 'known' (documented) and occult (only on ECG) AF. The colour-coded decision tree suggested that OAC would be recommended for the majority in AF when HAS-BLED (60/86, 70%) was used as the bleeding risk-prediction instrument. Despite this, only 12/60 (20%) were anticoagulated. When HEMORR2HAGES was incorporated instead, one patient was advised OAC, the remainder no treatment (57%) or an antiplatelet (42%).

DISCUSSION

Stroke risk was high and bleeding risk levels comparatively low, suggesting that the balance of risk may favor OAC for AF in this cohort of patients with advanced frailty. Despite this and the high prevalence of AF, OAC prescription rates were low. The decision-support tool used showed mixed results, depending on the bleeding-risk score incorporated, suggesting that while useful, they should not replace clinical judgement.

Role of C-Reactive Protein, White Blood Cell Counts, Bilirubin Levels, and Imaging in the Diagnosis of Acute Appendicitis as a Cause of Right Iliac Fossa Pain

Background Right iliac fossa (RIF) pain is one of the most common modalities of presentation to surgical emergency. It remains a challenge to the treating clinicians to accurately diagnose or to rule out appendicitis. Objective The aim of the study was to compare the efficacy of clinical impression, biochemical markers, and imaging in the diagnosis of RIF pain with special reference to appendicitis and their implication in reducing the negative appendicectomy rates. Methods All patients presenting to casualty with RIF pain were included in the study. Blood investigations including C-reactive protein (CRP), serum bilirubin, white blood cell counts (WBC), and ultrasound (USG) were done. Based on the clinical impression, patients were either posted for appendicectomy or observed in equivocal cases. Patients who had recurrent pain on follow-up underwent appendicectomy or underwent contrast-enhanced computed tomography (CECT) in equivocal cases. Patients who only had a single self-limiting episode with no other alternative diagnosis or had a normal CECT report were included in a non-specific RIF pain group. Results The negative appendicectomy rate was 8.2%. The mean value of WBC counts (9.57x109/L vs 7.88x109/L; p<0.05) and that of serum bilirubin (1.37 mg/dl vs 0.89mg/dl; p<0.05) in the appendicitis and non-appendicitis group, respectively, were statistically significant. The percentage of CRP positivity was higher in the appendicitis group (51.9% vs 15%; p<0.05). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for USG (84.2%, 77.17%, 85.4%, and 75.5%), for CRP (51.8%, 85%, 82%, and 57%), for WBC count (45.1%, 88%, 86.6%, and 48.3%), and for serum bilirubin (69.2%, 75%, 81.4%, and 60.5%) were statistically significant between the groups. Conclusion Imaging and biochemical investigations including bilirubin can act as useful adjuncts to the clinical diagnosis of appendicitis.

Electrochemical properties of reduced graphene oxide derived through camphor assisted combustion of graphite oxide

One-step synthesis of reduced graphene oxide (rGO) from graphite oxide (GO) using a camphor assisted combustion (CAC) process. The rGO with synthesis acquired carbon particles for improved supercapacitance.

Current trends in etiology, prognosis and therapeutic aspects of Parkinson's disease: a review

Parkinson's disease (PD) is a movement disorder, mainly affecting population consisting of the aged. PD occurs chiefly due to progressive loss of dopaminergic neurons in nigrostriatal pathway. Largely, PD patients suffer from non-motor symptoms, such as depression, anxiety, fatigue, and sleep disorders, that needs further investigation and addressing during PD research. Depression in PD is a predominant and complex symptom, and its pathology exists extrinsic to the nigrostriatal system. This disease can  ultimately be managed by a combination of regular physiotherapy and proper medication. Taking together the present scenario of PD, including the nature of disease, characteristics, treatment, diagnosis of the patients with PD, these outcomes were reviewed to be explored along with many speech-based solutions to PD in this study. This neurodegenerative disorder needs advancement in  research and development which  can help patients with PD to lead a normal life.